| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
635 |
631 |
$23K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
457 |
451 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
434 |
431 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
275 |
272 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
16 |
16 |
$583.77 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
13 |
13 |
$390.00 |
| V2750 |
Anti-reflective coating, per lens |
26 |
26 |
$0.00 |
| 92015 |
Determination of refractive state |
272 |
270 |
$0.00 |